Download Community-Associated Methicillin Resistant Staphylococcus Aureus

Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Emergence and Epidemiology of CommunityAssociated Methicillin-Resistant Staphylococcus
aureus in the United States
Overview
• Background / Terminology
• Outbreak Investigations
• Community emergence
• Reasonable approaches to prevention
and control (Expert Panel Summary)
Rachel J. Gorwitz, MD MPH
Centers for Disease Control and Prevention
Atlanta, GA
Hosted by Paul Webber
Sponsored by
JohnsonDiversey Inc.
www.johnsondiversey.com
[email protected]
www.webbertraining.com
Trends in S. aureus Antimicrobial
Resistance (Chambers EID 2001, NNIS, Fridkin NEJM 2005)
Penicillinase-producing
S. aureus
Hospital
100
Percent Resistance
Percent Resistance
100
Trends in S. aureus Antimicrobial
Resistance (Chambers EID 2001, NNIS, Fridkin NEJM 2005)
80
60
40
20
Hospital
Community
80
60
40
20
0
0
1940
1950
1960
1970
1980
1990
1940
2000
1950
1960
Trends in S. aureus Antimicrobial
Resistance (Chambers EID 2001, NNIS, Fridkin NEJM 2005)
Penicillinase-producing
S. aureus
Hospital
Community
80
1980
1990
2000
Trends in S. aureus Antimicrobial
Resistance (Chambers EID 2001, NNIS, Fridkin NEJM 2005)
60
40
MRSA
20
100
Percent Resistance
100
1970
Year
Year
Percent Resistance
Penicillinase-producing
S. aureus
Hospital
Community
80
Penicillinase-producing
S. aureus
60
40
MRSA
20
0
0
1940
1950
1960
1970
Year
1980
1990
2000
1940
1950
1960
1970
1980
1990
2000
Year
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Terminology
• Terminology has been inconsistent
Four Pediatric Deaths from Communityacquired Methicillin-Resistant S. aureus -Minnesota and North Dakota, 1997-1999
MRSA is an emerging community pathogen among
patients without established risk factors for MRSA
infection (e.g., recent hospitalization, recent surgery,
residence in a long-term-care facility, or injecting-drug
use).
MMWR 48:707; 1999
• Community-Onset (CO) MRSA: infection
diagnosed or index culture collected in
community
• Established risk factors (RFs): recent
hospitalization, surgery, dialysis, long-tern
care; indwelling catheter or percutaneous
medical device; history of MRSA
• Community-Acquired MRSA: Used for CO
infections or CO infections in patients without
established RFs, but difficult to establish with
certainty where acquisition occurred
• Community-Associated MRSA: CO infections
in persons without established RFs
Bacteriologic Differences in CAMRSA and HA-MRSA Isolates
CA-MRSA
HA-MRSA
Few agents
Multiple
agents
Type IV
Type II
PFGE Types
USA 300,
400
USA 100,
200
PVL toxin gene
Common
Rare
Antimicrobial
resistance
SCCmec (genetic
element carrying mecA
resistance gene)
Terminology
• “CA-MRSA” now sometimes used to
refer to MRSA strains with certain
bacteriologic properties
• However:
Panton-Valentine Leukocidin
(PVL) Toxin
• Necrotizing cytotoxin
• Associated with abscesses and severe
pneumonia
• Also found in some methicillinsusceptible S. aureus (MSSA) isolates
CA-MRSA Outbreaks
– No definitive bacteriologic criteria for
community strains
– Attributes may change over time,
particularly if community strains become
established in healthcare settings or vice
versa (differences in selective pressures,
interchange of genetic material)
– Eventually may be impossible to
distinguish CA-MRSA and HA-MRSA
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
CA-MRSA Outbreaks
• Often first detected as clusters of
abscesses or “spider bites”
• Various settings
– Sports participants: football, wrestlers,
fencers
– Correctional facilities: prisons, jails
– Military recruits
– Daycare and other institutional centers
– Newborn nurseries and other healthcare
settings
– Men who have sex with men
Competitive Sports
Methicillin-Resistant Staphylococcus
aureus Infections Among Competitive Sports
Participants --- Colorado, Indiana, Pennsylvania,
and Los Angeles County, 2000--2003
August 22, 2003 / 52(33);793-795
CA-MRSA Abscesses among
Professional Football Players
(Kazakova et al NEJM 2005;352:468-75)
• MRSA abscesses in 5/58
players at sites of turf burns
• Association with:
– BMI>30
– Lineman/Linebacker
– Recent antibiotic use
• Abx use
– 2.6 scripts/yr for Rams
– 0.2 scripts/yr for gen pop’n
• No MRSA on colonization
survey or environmental
sampling
CA-MRSA Abscesses among
Professional Football Players
(Kazakova et al NEJM 2005;352:468-75)
• Observational:
– Trainers providing wound care
had no access to hand hygiene
– Towels frequently shared
– Players often did not shower
before using whirlpool
– Weight-training equipment not
regularly cleaned
• Transmission controlled with
improved wound care, targeted
therapy, enhanced hygiene
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Turf Burns
Prevention and Control
• Cover all wounds
• Train athletes in first aid for wounds
and signs of infection
• Encourage good hygiene
• Discourage sharing of items
• Establish routine cleaning schedules
for shared equipment
• Encourage players to report skin
lesions
Correctional Facilities
Methicillin-Resistant Staphylococcus aureus
Skin or Soft Tissue Infections in a State Prison –
Mississippi, 2000 (MMWR 2001 50:919-22)
• 59 skin infections in 3000 inmate prison
• Case-patients frequently reported:
helping or being helped by other
inmates with wound care, lancing own or
other inmates’ boils with fingernails or
tweezers, sharing potentially
contaminated personal items (linen,
pillows, clothing, tweezers)
• High nasal carriage rate of MRSA (4.9%)
MRSA Outbreaks in Correctional Facilities
Methicillin-Resistant Staphylococcus
aureus Infections in Correctional Facilities, 2001-2003 October 17, 2003/ 52(41);992-996
• Georgia
• California
• Texas
Intervention to Reduce the Incidence of MRSA
Skin Infections in a Correctional Facility in
Georgia (Wooten et al ICHE 2004;25:402-7)
• 16 cases of MRSA skin lesions in 200-bed
detention center
• Prior to intervention:
– Co-pay required for clinic visit
– Lesions treated with warm compresses and
topical antibiotics (no capacity for I&D)
– Soap kept in locked drawers
• Rates declined significantly after
implementing measures to improve skin
disease screening, personal hygiene,
wound care, and antimicrobial therapy
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Contributing Factors to MRSA Spread
in Correctional Facilities
• Barriers to routine hygiene
– Access to soap limited
– Mental health problems contributed to poor adherence
– Improper handling of laundry
• Barriers to inmates accessing the medical system
– Cost
– Language and literacy
– Fear
• Barriers within the medical system
– Frequent medical staff turnover and understaffing
– Limited services available (e.g., no I & D)
– Lack of coordination between facilities
• Unrecognized cause of skin infections
Prevention and Control
• Collaborated with Bureau of Prisons*
– Implement skin infection screening and
monitoring
– Culture suspect lesions and provide targeted
therapy
– Improve inmate hygiene (education, availability of
soap, etc)
– Improve access to wound care and trained
healthcare staff
– Additional Interventions (antiseptic washes, nasal
decolonization) to be considered in consultation
with public health
– Cultures rarely performed; lesions attributed to spider bites
• Crowding
*http://www.bop.gov/news/PDFs/mrsa.pdf
Military Trainees
Military Training Facility, 2001-2003
Cases of CA-MRSA Soft Tissue Infections
ƒ235 skin infections
ƒTransmission peaked in later weeks
Zinderman, Emerg Infect Dis Vol 10, May 2004 941-944
Military Training Facility, 2001-2003
Cases of CA-MRSA Soft Tissue Infections
Other Outbreaks
ƒImproved
diagnosis/TX*
therapy
ƒHand sanitizers for recruits
ƒAntibacterial soap
ƒDaily showers enforced
ƒProhibited of sharing towels
ƒConcordant
Zinderman, Emerg Infect Dis Vol 10, May 2004 941-944
* Miocycline or TMP/Sulfa with rifampin and mupirocin (10 days)
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Skin Infections in a
Religious Community
12
10
9
• 24 confirmed or probable cases
• Antibiotic use in past year and use of
community sauna were independently
associated with disease
• MRSA (different from outbreak strain)
isolated from sauna
• Transmission interrupted with multifaceted intervention and closing sauna
Confirmed Case
Probable Case
Possible Case
8
7
6
5
4
3
2
1
0
June July
Aug Sept
Oct
2003
Nov
Dec
Jan
Feb
Mar
Apr
Date of Onset
May June July
Aug Sept
Oct
Nov
2004
Tattoo Recipients
• Outbreaks reported in
several states
associated with licensed
and unlicensed
tattooing
• Investigations underway
Hospital Transmission of CAMRSA
• Hospital transmission of CA-MRSA
among post-partum women, NY (Saiman L,
CID, 2003;37:1313-9)
• CA-MRSA in a NICU, TX (Healy CM, CID,
2004;39:1460-6)
• Tattoo parties,
improvised equipment
CA-MRSA outbreaks among otherwise
healthy full-term newborns
• Clusters of MRSA skin infections among
newborns delivered at a common facility
• Onset of symptoms in 1st few weeks of life –
usually about a week after discharge from
term nursery
• No risk factors for acquisition following
discharge identified
• Resolved after reinforcement of nursery
infection control practices and, in some
cases, decolonization of colonized health
care workers
CA-MRSA Causing Infections
In the Hospital – Uruguay 2002-2004
80
# of Infections
No. of Skin Infections
11
Skin Infections in a
Religious Community
70
60
50
All MRSA
HA-MRSA
CA-MRSA
40
30
20
10
0
1st
2nd
3rd
4th
5th
6th
7th
8th
Quarter
Benoit, Estivariz EIS
Uruguay Trip Report
Number of infections by quarter for
Asocacion Espanola, Uruguay
July 2002-July 2004
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
CA-MRSA Differs from HA-MRSA
CA-MRSA Outbreaks:
Summary
PFGE Typing of ORSA from the US: Establishing a National Database.
McDougal et al. J Clin Microbiol 2003;41:5113-20.
100%
80%
60%
A Few CA-MRSA Strains Cause Most
Community Outbreaks
CA-MRSA: Factors for Transmission
Crowding
Pneumonia (AL, AR, IL, MD, TX, WA)
Missouri
California
Athletes
Pennsylvania
Colorado
Mississippi
Texas
Prisoners
Georgia
Tennessee
Texas
Missouri
Children
California
USA300-114 Community
USA100
Hospital Strain
Hospital Strain
USA200
Compromised Skin
Transmission Dynamics
CA-MRSA Outbreaks
Colonized
Infected
Susceptible
Environment
Contaminated Surfaces
and Shared Items
Frequent Contact
Cleanliness
CA-MRSA Outbreak Control
Measures
• Multi-component strategies used
(difficult to assess individual
contribution of each)
• Strategies focusing on increased
awareness, early detection and
appropriate management, enhanced
hygiene, and maintenance of a clean
environment appear to have been
successful at interrupting
transmission
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Methicillin-Resistant
Staphylococcus aureus in Three
Communities
CA-MRSA:
Emergence in the Community
• Fridkin SK. NEJM 2005;352:1436-44.
• Emerging Infections Program – Active
Bacterial Core Surveillance (ABCs)
• 2001-2002
• Atlanta, Baltimore, Minnesota
• Laboratory-based surveillance, all cultureconfirmed (invasive and non-invasive)
infections in surveillance area
• Determined absence of established risk
factors by record review, patient interview
Incidence of CA-MRSA Disease in Atlanta and
Baltimore, According to Race and Age Group
CA-MRSA Prevalence
Varies by Region
Healthcare-Associated MRSA
Community-Associated MRSA
12%
20%
9%
Atlanta, 2001-2002
Baltimore, 2002
26 per 100,000
18 per 100,000
Incidence, Cases
per 100,000
80
Black
White
70
60
50
40
30
20
10
Minnesota
n=3714
Atlanta
n=7819
Baltimore
n=1720
0
<2
2-18
19-64
80
70
60
50
40
30
20
10
0
>64
Age Group (yr)
Black
White
<2
2-18
19-64
>64
Age Group (yr)
CA-MRSA Incidence, cases per 100,000
CA-MRSA Prevalence in Three Sites – ABCS/EIP
50
CA-MRSA Incidence
Varies by Race
CA-MRSA Predominantly
Causes Skin Disease
Disease Syndrome
(%)
45
40
35
30
African American
White
Total
25
20
15
10
5
Skin/soft tissue
Wound (Traumatic)
Urinary Tract Infection
Sinusitis
Bacteremia
Pneumonia
1,266 (77%)
157 (10%)
64 (4%)
61 (4%)
43 (3%)
31 (2%)
0
Atlanta
Baltimore
Incidence of CA-MRSA by Race, ABCS/EIP
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Infecting Strain of CA-MRSA Often
Resistant to Prescribed Antimicrobial
CA-MRSA in Hawaii, 2001-2003
• Retrospective chart review
of patients with MRSA
infection, 2001-2003
• 73% of CA-MRSA infections treated
initially with an antimicrobial to
which the infecting strain was
resistant
• Among patients with SSTIs, therapy
to which the infecting strain was
resistant did not appear to be
associated with adverse outcomes
• Four health-care facilities
(40% of acute care beds):
–
–
–
–
Children and woman’s center
Private urban clinic
County urban hospital
Rural community hospital
Estivariz: MMWR 53(33);767-770, 2004
Increase in CA-MRSA Infections,
Hawaii 2001-03
Number CA-MRSA cases
Percentage CA-MRSA
Estivariz EIS ‘03
80
70
60
50
40
30
20
0
JulSep
OctDec
JanMar
AprJun
JulSep
OctDec
JanMar
AprJun
CA-MRSA is Increasing in Four Facilities in Hawaii, 2001-2003
2001
2002
2003
Race Distribution of Case-patients
Hawaii, 2001-2003
CA-MRSA
(N=346)
60%
60%
50%
40%
30%
20%
10%
Pediatric
Hospital
30%
*
10%
Pacific
Islanders
White
Others
Total
CA-MRSA Prevalence at Four Facilities in Hawaii, 2001-3
S. aureus Community-Acquired Pneumonia
Following Influenza-Like Illness, 2003-4
Characteristic
40%
Asian
Center A Center B Center C Center D
Hawaii Population
(N=1,175,595)
*
50%
0%
Estivariz EIS ‘03
70%
0%
10
20%
CA-MRSA Prevalence
Varies
by Age, Hawaii 2001-2003
80%
No. (%)
n=17
21 (8 mos.-62 yrs)
Age, median [range]
9 (52)
Sex, female
15 (88)
MRSA
Race
10 (59)
White
7 (41)
Black
5 (29)
Underlying disease*
4 (24)
MRSA risk factors
1 (6)
Documented influenza vaccination
*One each: Diabetes, multiple sclerosis, abdominal wall malformation, cystic fibrosis, eczema
• P<0.05 for CA-MRSA vs expected
• Data from 2001 Hawaii Health Survey, HI State DOH
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
S. aureus Community-Acquired Pneumonia
Following Influenza-Like Illness, 2003-4
Hypotension (systolic<90mmHg)
Leukopenia (WBC < 3,500mm3)
Thrombocytopenia (<150,000mm3)
Hospitalization
ICU (8 intubated)
Death (Median Age = 28)
90%
100%
No. (%)
n=17
80%
Characteristic
Evidence of preceding influenza illness
Clinical symptoms only
Laboratory Confirmed
Rapid antigen test
Paired serology
Fluorescent antibody staining
Eight Indistinguishable MRSA
Patterns from CAP Patients
State
Texas
Arkansas
Maryland
Maryland
Maryland
Washington
Alabama
Illinois
Missouri
Maryland
5 (29)
12 (71)
10 (59)
1 (6)
1 (6)
7 (41)
4 (24)
4 (24)
16 (94)
13 (81)
5 (29)
CA-MRSA Transmission
S. aureus Colonization
NHANES Nasal Swab Survey 2001-2, Kuehnert et al.
Community
50
S. aureus 32%
MRSA 0.8%
45
Prevalence (%)
40
Group Setting
MRSA
35
30
Male
Female
25
20
15
10
5
• Differs from
hospital strains
• PVL toxin +
• Resistant to
standard
therapy
0
1--5
6--11
12--19 20--29 30--39 40--49 50--59 60--69
• Crowding
• Contaminated items
or environment
Skin
Abscesses
• Contact
• Compromised skin
• Cleanliness
70+
Age (years)
CA-MRSA Prevention and Control
Prevention and Control of
Community-Associated MethicillinResistant Staphylococcus aureus
CA-MRSA Expert Panel Summary
• Meeting July 2004
–
–
–
–
–
American Academy of Pediatrics
Peds Infectious Disease Society
Amer College of Emergency Physicians
State and Local Health Departments
FDA
• Goals
Rachel J. Gorwitz, MD MPH
Division of Healthcare Quality Promotion
National Center for Infectious Diseases
DRAFT
– Identify reasonable approaches to prevention
and control of MRSA in the community
– Identify needed areas for research
DRAFT
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Clinical Considerations - Evaluation
Clinical Considerations
Increase Awareness
• MRSA belongs in the differential diagnosis
of skin and soft tissue infections (SSTI’s)
compatible with S. aureus infection:
• Abscesses, pustular
lesions, “boils”
• “Spider bites”
• Cellulitis?
DRAFT
Clinical Considerations - Evaluation
Clinical Considerations - Evaluation
Increase Awareness
• MRSA should also be considered in
differential diagnosis of severe disease
compatible with S. aureus infection:
Collect Diagnostic Specimens
• Obtain material for culture
– Guides clinical management
– Sepsis syndrome
– Contributes to knowledge of local
prevalence, epidemiology, susceptibility
patterns
– Osteomyelitis
– Necrotizing pneumonia
– Septic arthritis
– Necrotizing fasciitis
DRAFT
DRAFT
Clinical Considerations Management
Incision and Drainage Should Be Routine
• Primary therapy for abscesses
• May be adequate sole therapy in
some circumstances
Clinical Considerations Management
Adequate Follow-Up Must be Maintained
• Develop follow-up plan for all nonhospitalized patients
• Instructions to return if:
– Develop systemic symptoms
– Worsening local symptoms
– No improvement in 48-72 hours
• Provider education / refreshers on
appropriate technique may be
necessary
DRAFT
DRAFT
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Clinical Considerations Management
Clinical Considerations Management
Antimicrobial Selection
Empiric Antimicrobial Therapy
May Be Needed for SSTIs
• Beta-lactams still appropriate first-line
therapy for SSTIs in some circumstances?
• Significant associated cellulitis
• Take into account:
• Systemic signs of illness
– Local prevalence of MRSA
• Associated co-morbidities
– Severity of illness
– Patient co-morbidities
DRAFT
DRAFT
Clinical Considerations Management
Clinical Considerations Management
Antimicrobial Selection (SSTIs)
Inducible Clindamycin Resistance
• Mediated by erm gene
• Isolates appear macrolide (erythromycin)-resistant
and clindamycin-susceptible on routine susceptibility
testing
• In vitro resistance to clindamycin can occur during a
course of therapy
• Detected by a D-test, or double disk diffusion test
• Clinical implications of positive D-test unclear, but
should check for inducible resistance and avoid
clindamycin if detected
• Alternate agents:
– Clindamycin
– TMP/SMX
– Tetracyclines
– Rifampin (in combination with other agent)
– Linezolid
• More data needed to establish effectiveness!
DRAFT
Clinical Considerations Management
Percentage CA-MRSA
DRAFT
80%
70%
60%
50%
40%
30%
20%
10%
0%
Center Center Center Center Total
A
B
C
D
Antimicrobial Selection
• Not optimal for MRSA:
– Macrolides
– Fluoroquinolones
• High prevalence of resistance or potential
for rapid development of resistance
DRAFT
Clinical Considerations
- Management
Use Local Data for Treatment
• MRSA prevalence and susceptibility to
alternate agents vary geographically
• Local epidemiologic risk factors may be
useful in assessing likelihood of MRSA in
a given patient
DRAFT
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Clinical Considerations
Clinical Considerations
Patient Education
• Critical component of case management
– Wound care
– Hygiene
• Hand washing
• Regular bathing
– Avoid sharing of potentially contaminated
objects
DRAFT
Clinical Considerations
Decolonization Regimens
• Topical Nasal Agents
– Mupirocin, Others
• Antiseptic Body Washes
– Chlorhexidine, Others
• Oral antimicrobials
– TMP/SMX + Rifampin, Others
– Infected individuals only
• Single, short courses
Management of Household Clusters and
Recurrent Disease
– Education is critical
– Instruct patients and household members
to seek care early so that prompt
appropriate treatment of new infections
can be provided
– Decolonization???
DRAFT
Clinical Considerations
Management of Household Clusters and
Recurrent Disease: Decolonization
– Data from healthcare settings (pre-op,
dialysis, long-term care):
• Regimens can be effective in eliminating
colonization, at least in the short term
• Effectiveness in preventing disease less clear
– Almost no data on effectiveness in
community setting
– Resistance can emerge
– Basic strategies should be optimized first
DRAFT
DRAFT
Public Health Intervention
Public Health Intervention
When to Investigate
• Consider investigation when cultureproven MRSA cases have been
detected in a cluster among
epidemiologically-linked individuals in
the community
DRAFT
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
Public Health Intervention
Public Health Intervention
When to Investigate
• Decision to investigate should take into
account various factors
– Number of cases and temporal proximity of the
cluster
– Setting in which transmission is occurring
– Severity of illness among cases
– Presence of ongoing transmission or recurrent
illness among cohort members
– Host factors of those likely to be infected
– Likelihood that an intervention could be
successfully implemented
DRAFT
Components of Interventions
• Enhance surveillance
• Target empiric therapy to the pattern of
the outbreak strain
• Educate on wound care and wound
containment
• Promote enhanced personal hygiene
and limit sharing of personal items
• Consider excluding patients from certain
activities
• Achieve and maintain a clean
environment
DRAFT
Public Health Intervention
Public Health Intervention
Risk Factor Study?
• Can be labor and resource intensive
• Not always necessary for outbreak
management
• Consider when:
– Cluster occurs in a new setting
– Results are likely to:
DRAFT
• Directly impact control efforts
• Contribute to general understanding of the
disease and future prevention efforts
Colonization Swab Surveys?
• Have been used in many published
investigations
• Yield has often been low
• Not generally necessary to direct control
and prevention efforts
• May be useful:
DRAFT
Components of a
Public Health Intervention
Decolonization?
• No data to support efficacy in
preventing disease transmission in the
community; trials are needed.
• Control of previous outbreaks has been
achieved without use of decolonization
• Emphasis should be placed on basic
control strategies first
DRAFT
– To determine extent of or identify risk factors
for transmission (“carrier-control” study)
– To contribute to the understanding of CAMRSA epidemiology (non-nasal colonization
sites)
Conclusions
• Various studies are underway and more
are needed to determine best methods for
control and prevention of MRSA in the
community
• Strategies focusing on increased
awareness, early detection and
appropriate management, enhanced
hygiene, and maintenance of a clean
environment appear to have been
successful
DRAFT
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Community-Associated Methicillin Resistant Staphylococcus Aureus
Dr. Rachel Gorwitz, CDC
Sponsored by JohnsonDiversey www.johnsondiversey.com
CA-MRSA Working Group Meeting
Participants, July 2004
Gordon L. Archer
Carol L. Baker
Elizabeth Bancroft
Henry F. Chambers
Robert S. Daum
Jeffrey S. Duchin
Monica Farley
James Hadler
Jim Jorgensen
Sheldon K. Kaplan
Newton E. Kendig
Kathleen Harriman
Franklin D. Lowy
Ruth Lynfield
J. Kathryn MacDonald
Loren Miller
Gregory Moran
Olga Nuno
John H. Powers
L. Barth Reller
Nalini Singh
Marcus Zervos
Craig Zinderman
CDC
Daniel B. Jernigan*
John Jernigan*
Jay C. Butler
Denise Cardo
Roberta Carey
Rachel Gorwitz
Jeffrey C. Hageman
Thomas Hennessy
James M. Hughes
Jean Patel
Fred Tenover
J. Todd Weber
Rachel Gorwitz, MD MPH
[email protected]
Division of Healthcare Quality Promotion
National Center for Infectious Diseases
*Meeting Co-Chair
Enhanced Recordings
on CD
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A Webber Training Teleclass
Hosted by Paul Webber [email protected]
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